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CHECK YOUR HOSPITAL BILL

male-teenagersI suppose this is something that we all know that we should do but here are reasons from women like you…

CHECK YOUR HOSPITAL BILL!

Shared from a Triad Birth Doula Facebook post on October 7 & 8, 2016:

Yesterday I posted an article from CBS, “Dad says hospital charged $39 to hold newborn baby”, and a mama shared something VERY IMPORTANT!!!

Mama: Just FYI for patients at women’s. I asked for an itemized bill, and they charged me for numerous things I declined. Eye drops, sugar drops, numerous visits with lactation that didn’t actually occur. When I called they said “oh you must be self pay. Pat…See More

Triad Birth Doula: Are you kidding me??? May I make separate post of this?

Mama: Of course, and no I’m not kidding. The only reason I asked for an itemized statement, was because when I declined the sugar drops, the nurse went ahead and scanned them anyways. Didn’t even open them. I wanted to check on that. That’s when I saw the eye drops, that were not given, and all the lactation visits.

Triad Birth Doula: Thank you! Women need to know this! What are the sugar drops? Haven’t heard of that.

Mama: When they draw blood, for the blood test kit they give it to babies as a distraction. Just a couple drops of sugar water, no big deal. I don’t know the proper term. In my survey I included a whole letter, about all this, plus I called and spoke with an administrator, (who made the statement above) also told me the lactation charges are automatically billed. So basically, if they walk in your room, you are billed $50, even if you say no thank you and they leave and do nothing. It’s not about the money, But to get a bill, and see $250 worth of charges that I declined and did not receive is disgusting. After this experience, I request an itemized bill for everything!!

Triad Birth Doula: Wow! Again…thank you for sharing!!!

2nd Mama: This happened to me as well. I had to ask for an itemized bill for my AFLAC plan, and when I saw a few things and was curious, I started googling things. Discovered I was charged for at least $300 worth of supplies/services that weren’t used. They charged for a standard IV as well as a Pitocin IV which I specifically declined both. They charged a lot of random things for the baby as well – like a nebulizer that she didn’t use/need at all.
I asked my friend who is an L&D charge nurse, and she said they scan things that are checked in to the room as a precaution. But that they also have to chart everything that happens to and is given to the patient, so if you disputed it, they would be able to take it off the bill because they’ll see it’s not in the actual chart/files.
I’m with (1st Mama) – will always ask for itemized bills from now on!!

Triad Birth Doula: Exactly!!! May I share your comment?

2nd Mama: Yes – anything to help make this stop.

If this has happened to you, please share your story on https://www.facebook.com/TriadBirthDoula/

 

 

 

PROM AT TERM… Some Evidence

index-14PROM AT TERM… Some Evidence  

written by Jackie Levine

 

Many define PROM as any release of waters before labor has actually begun…. whether at 32 or 42 weeks. There are recommendations about the management of PROM, but there’ is no definitive proclamation from the CDC or anywhere else  about what one “must” do to a woman after a certain number of hours have gone by without some contrax, especially at “term”.  The statistics about PROM pretty much don’t change….around the world the same % of women will go into labor and will birth  after 12-24 hours,  the same % after 48 hours, then 72 hours, etc, with the same low per centage of mothers and babies sustaining infection. 

It seems that the whole establishment is not convinced about exactly how to handle PROM, and the studies continue. You can find  ACOG practice bulletins on this at least since 2000.  The studies don’t all study things the same way….yes to pelvic exams?  No exams?  Expectant management with testing for fever or other signs of infection?  When and how?  Many mothers are really in early early labor, water breaks but there are no discernible contrax, yet the cervix is slowly slowly beginning to change.  Do these women as qualify as PROM and should they be put in the 24-hour queue? Or should they br  “classified” as being in labor, however early, which takes the “P” out of PROM…

The latest info on this is from the Cochrane, 2014. Here’s the “Background” and the “Conclusion”, followed by the citation.  This information may help mothers-to-be to make the  decision about whether to be treated according to routine, cookie-cutter care  that her OB applies to all clients with PROM at term, or to make sure that  a truly genuine  assessment of her  and her baby’s individual, actual health status is made.

BACKGROUND:

Prelabor rupture of the membranes (PROM) at or near term (defined in this review as 36 weeks’ gestation or beyond) increases the risk of infection for the woman and her baby. The routine use of antibiotics for women at the time of term PROM may reduce this risk. However, due to increasing problems with bacterial resistance and the risk of maternal anaphylaxis with antibiotic use, it is important to assess the evidence addressing risks and benefits in order to ensure judicious use of antibiotics. This review was undertaken to assess the balance of risks and benefits to the mother and infant of antibiotic prophylaxis for PROM at or near term.

AUTHORS’ CONCLUSIONS:

This updated review demonstrates no convincing evidence of benefit for mothers or neonates from the routine use of antibiotics for PROM at or near term. We are unable to adequately assess the risk of short- and long-term harms from the use of antibiotics due to the unavailability of data. Given the unmeasured potential adverse effects of antibiotic use, the potential for the development of resistant organisms, and the low risk of maternal infection in the control group, the routine use of antibiotics for PROM at or near term in the absence of confirmed maternal infection should be avoided.

Cochrane Database Syst Rev. 2014 Oct 29;10:CD001807. doi: 10.1002/14651858.CD001807.pub2.Antibiotics for prelabour rupture of membranes at or near term.Wojcieszek AM1Stock OMFlenady V.

Here’s another concise recent piece of information: JUNE 18, 2015/BCAYLEY Summary: For women with pre-labor rupture of membranes occurring after 36 weeks’ gestation (who do not have a confirmed infection), use of antibiotics does not appear to reduce the risks of endometritis, early-onset neonatal sepsis, maternal infectious morbidity, stillbirth, or neonatal mortality; but use of antibiotics in this situation may be associated with increased rates of cesarean delivery and maternal length of stay in hospital, and potentially could be associated with adverse medication side effects from antibiotic use and the potential for the development of resistant organisms. (In other words, avoiding antibiotic use for prelabor rupture of membranes after 36 weeks’ gestation unless there is a confirmed maternal infection, may be associated with lower risks adverse antibiotic effects, lower rates of cesarean delivery, and shorter maternal stay in hospital; without increasing the risks of any neonatal or maternal morbidity or mortality.)

http://www.ncbi.nlm.nih.gov/m/pubmed/25352443/

 

 

Thank you, Jackie! You know I, Triad Birth Doula, always enjoy sharing your articles.
Interesting thing…in my experience here in NC, I have only had antibiotics offered once for PROM, which mother refused much to the doctor’s distress.
I have had a couple of mothers become sick after 24+ hours and were then given antibiotics as soon as fever appeared. But no wonder with all of the vaginal exams, catheter and internal monitor due to pitocin & epidural.
I have a theory about avoiding PROM….
Around here, and with my clients, I feel that a sudden drop of barometric pressure is all too often the culprit of PROM. So I suggest that when we know this type of weather is going to occur, drink extra water and if safe get in bath tub. If not safe (lightening) lie down so at least gravity is taken out of the picture.
Some may laugh at me but I believe in this.

 

 

 

YOU must make it happen!

When you give birth, you can have a quiet, peaceful, private environment…even in the hospital but YOU must make this happen.

It will be YOUR responsibility to share your wishes with your care provider.
It will be YOUR responsibility to share with the hospital staff that this is what you want.
YOU will need to tell them that you want dim lights, soft voices, minimum interruptions, no spectators (students/trainees).

You can accomplish this by discussing this with your care provider, by including it in your Birth Plan/Wishes, by telling the staff when you first arrive, by reminding your care provider, and by having your partner remind everyone as needed as labor progresses.

The environment you establish can be very important to your, and your baby’s, experience.
But YOU must make it happen.

Baby Belly Bazaar March 2015

bbb 4x6 card front (2)It is almost time for the Baby Belly Bazaar and the excitement is growing!!!

Fifty vendors are expected and several talented artists are prepared to decorate your baby belly!

on line sponsors

Our sponsors alone indicate what a wide range of information, education and fun that will be available to you!

And there are many more vendors!

Don’t miss this exciting event that is just for you and your baby!!!

Saturday; March 21st; 11am-3pm;  Greensboro Cultural Center

When a woman is first administered an epidural…she needs her doula.

indexWhen a woman is first administered an epidural…she needs her doula. In fact, she and her partner need, and want, their doula* very, very, much!

 
In most cases when a doula is present, this woman has just given up her dream to have a natural birth. This is difficult for her. And that is not even mentioning the pain she is dealing with at the time. She hurts; she is upset; she is scared. She may even feel that imaagesshe has just been forced down a path she did not want. She knows that this is a turning point in her labor and takes her closer to the possibility to major surgery. And all of this has a huge impact on her partner.

 
It is obvious…they both need the woman they have come to know and trust over the past several months. They jwant the woman they have handpicked to be with them throughout this journey of childbirth. They want that one consistent and ever present woman. They want their doula.

 
And why shouldn’t their doula remain with them? Around these parts, the anesthesiologist do not mind. There is plenty of space in the room. And the doula knows to stay out of the way. She is beneficial because imageksshe knows how to calm the woman so that she is not moving about during this precise procedure. She knows how to keep a watchful eye on the partner. She offers a sense of peace and calm for this couple with whom she has spent so many hours, as no one else in the room can offer.

 
imagesThen there are those first delicate moments immediately following the administration of the drugs. The woman’s blood pressure may drop; the baby may not react well; etc. Again…this is the time to have the soothing presence of the doula. This is the very important time for both mother and partner to be assured by this woman they trust so much.

 


The doula knows that the medical team must do what they need to do at such an intense time and is prepared to remind this couple of what is occurring, as she has already reviewed the possibilities weeks ago. She is also prepared to remind the mother of her options, her choices, with all the pros and cons. She is able to explain to the couple what might be occurring, even while the mother and baby are being cared for by the medical team.

 
kWhen an epidural is administered, which is a turning point in a woman’s labor, the woman and her partner need and want their doula.

 
It is very simple…the doula gives them what no one else can.

 

*For the purpose of this article, when I refer to a doula I am referring to a certified doula, or one in the process of certification, who abides by a set Code of Ethics and Standard of Practice.

The Squat Bar

The squat bar can be an awesome tool to use when you are pushing your baby into this world. But it can be very confusing as to how to use it…and feel strange. I will try to give you a feel for it with the pictures and comments below. Unfortunately, it is rare to have an opportunity to actually practice with a bar.

3cbd034e9e27cd1efe410ff6801cc37b.wix_mp_1024 This is how the bar and the bed are positioned. You sit right on edge of raised portion until a contraction comes. Then with a contraction, you squat so your bottom is not touching bed, and you push.

khkhjymjjkujPushing like this at first can feel a little insecure because all of your weight is on that lowered portion of the bed. It will help you to know that your support person is right there with you.
It may also help to have entire bed lower to the ground so you do not feel like you might fall off a cliff.

hNote how the bar is tilted towards the foot of the bed and all of your weight is on lowered portion.

 

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Between contractions, you can try to rest the weight of your body back onto the higher portion of the bed.

 

index (2)Then, with a contraction go into a deep squat, supporting yourself with the bar.

squatting bar on hospital bedRemember, your support people are right there for you and will help steady you. And having the entire bed lower to the floor will also help you to feel more secure in this position. Everyone else will accommodate your position.

a4128bd43637fbfa63d5aa40946a1e19.wix_mp_1024This is an awesome way to use the squat bar and “tug-of-war” position. Please note how she is not on her bottom; how she is really in a squat but on her side. Very useful with an epidural. “Tug-of-war” position is usually used for pushing; not labor.

maxresdefaultI’m not sure about this kind of position because while it simulates a squat, it leaves her sitting on her butt. It does, however, allow for that “tug-of-war” position.

fThis position allows you to be asymmetrical while being able to take some weight off of the lower body by leaning on the bar. If possible, spread your legs as wide as you can.

 

Most of these positions can also be good for labor. It is considered best to use the bar for a deep squat during a contraction. Sit back and rest in between. You want to be sure that when you are in that deep squat, you are NOT PUSHING until your cervix is ready.

If your hospital does not have squat bars…start asking for them. This is how change can occur!

Tools for Birth

When you are ready to give birth, you will have an arsenal full of tools you wish to use during this most important and exciting experience.  <<   

You will have all of your recent education, your birth wishes, your doula, your midwife. You will <have your birth ball, your birth pool, your willingness to do what you need to do.

Your desired ambiance will be created through lighting, music and aromatherapy. <And most important…you will have your open mind.

If things might not go as you originally hoped they would…you will have another set of tools that some call interventions. And you will know in your heart that there is a time and place for every intervention that man has created. <And so your tools will have grown to include pitocin, pain medication, epidural, and if need be, a cesarean.

And in the end, you will have your new baby in your arms. <Your dream of many days and weeks will be complete.< Perhaps not exactly as you had hoped and planned. And for that you may need to grieve. And that grieving will be good.

But you will forever know that you had prepared, and used,  your tools. And you had prepared, and used, your open mind. <And then, and for always, you will have your baby; your family.

 

Hypnobabies®

Hypnobabies® says…
“Enjoy your baby’s birth in comfort, joy and love…”

And that is exactly what I witnessed!

But this type of birth is only going to work for you if you believe and if you invest yourself…also known as practice and prepare.

Hypnobabies® was not the only thing going on with this birth.

There was just so much love in this room…between mom and dad and son and parents. It was perfect the way dad read the script while son performed the touching. And, of course, when there is this much love you know that the oxytocin levels are unbelievable. Then add the soothing effect of the warm waters of a birth pool…well, no wonder this labor did not go on for hours on end.

And just to make this birth even more special…a well known doctor, Dr. Stringer of Central Carolina OB/GYN in Greensboro, NC, was the one who had the privilege of guiding this baby to her momma’s waiting arms.

A week or so later and it was finally my turn…

10535599_747441471985656_4253252612566365345_o (640x360) 20141001_113153 (640x360)

     I love my work!!! Thank you, Mom & Dad!!!

https://www.hypnobabies.com/

What Impact Can IV Fluids Have on Mother, Baby and Breastfeeding?

 A Quick Look.

images (4)Written by guest author, Jacqueline Levine

Having IV fluids is a medical procedure. It’s meant to restore normal body fluid balance when there’s blood loss or dehydration, but the Listening to Mother’s Survey1 reports that 83% of women have IV in labor. Having a routine IV , as so many do, isn’t risk-free.2 An excess of IV fluid can dilute red blood cells and other components of the blood like clotting factors, so that less oxygen gets to the uterus and less to the fetus, increasing the possibility of post partum anemia or hemorrhage3,4.
Too much fluid can overcome normal pressure in blood vessels, and fluid goes where it shouldn’t. The mother’s and/or baby’s lungs can become “wet”5. Large amounts of fluid given quickly (a bolus) can interfere with the activity of the uterus.6 The type of IV fluids given can have unhappy effects as well, such as hyponatremia which can cause seizures, and symptomatic hypoglycemia in the baby7,8,9. Plastic IV lines may “off-gas” phthalates and other chemicals that are harmful. This list is brief. There are lots of studies that show harms from routine use of IV. Even the safety of “normal saline” has come under scrutiny.10 And the effect of IV administration lasts well into the days after the mother is disconnected from her hanging bag of fluids.
Fluid has weight, of course; haven’t you heard that helpful little reminder, “a pint’s a pound the world around”? If a laboring mother gets bag after bag of IV fluids, odds are that her baby will be born with an inflated birth weight. Breastfeeding success is often measured by how quickly the baby regains its birth weight after the normal weight loss in the first week or so. What exactly might that baby’s normal birth weight have been? What does it mean to the motherbaby pair when of them both are full of extra fluids? Water moves everywhere in the mother’s body and aside from ankles and wrists and fingers and toes that can be swollen like sausages, breasts and nipples hold water as well. A swollen breast with taut skin makes latching difficult. This scenario is often the beginning of early nursing troubles10: the transition from colostrum to mature milk may be delayed in a water-swollen breast, and a newborn may not able to achieve a deep latch so he can’t get sufficient food and cannot stimulate the breast well. Supplementation comes next. We know it and the studies show it. There are remedies to those situations…good support for mother and baby… but best-evidence, optimal maternity care is the answer.
Supplementation frequently comes next. We know it and the studies show it. There surely are remedies to the problem of swollen breasts, like Reverse Pressure Softening, and methods to build up milk supply, and ways to support better positioning for a baby who is having latch difficulties..
But the overarching answer is for mothers to be aware of best-evidence, optimal maternity care, and to understand their rights as patients to refuse routine interventions. By avoiding IV fluids except for compelling medical reasons, mothers will be able to avoid the negative consequences of fluid overload to their babies and themselves, and give themselves a chance at better breastfeeding beginnings.

Jacqueline (Jackie) Levine, LCCE, FACCE, CD(DONA), CLC is committed to providing a continuum of care for underserved women at PlannedJackie-Levine Parenthood, on Long Island, NY, where she has provided free Lamaze education, birth and breastfeeding support to all the women in her classes for the last 9 years. She is a guest lecturer on Childbirth in the US at CW Post, has worked for CIMS, contributed to the Lamaze e-newsletter Building Confidence Week-by-Week , all after her 30-year career as a designer in the garment center. Jackie is a recipient of the Lamaze Community Outreach Award, mother of three and Grandmother of five.” Science & Sensibility

 
References:
1-DeClerq E, Sakala C, Corry MP, et al. Listening to Mothers ll: Report of the Second National US Survey of Women’s Childbearing Experiences. New York: Childbirth Connection
2-Wasserfstrum N. Issues in fluid management during labor; general considerations. Clin Obstet Gynecol 1992;35(3):505-13
3-Carvalho JC, Mathias RS, Intravenous Hydration in obstetrics. Intl Anesthesiol Clin 1994:32(2):103-15
4- Carvalho JC, Mathias RS,Senra WG et al. Hemoglobin concentration variation and blood volume expansion during epidural anesthesia for cesarean section. Reg Anesth1991;16(1S):73
5-Gonik B., Cotton DB.,Peripartum colloid osmotic changes; influence of intravenous hydration. American Journal Obstet Gynecol1984;150(1):99-100
6-Cheek, T.G., Samuels, P.,Miller, F., Tobin, M., Gutshe, B.B. Iv load decreases uterine activity in active labor. Journal of Anaesthesia 1996;77:632-635
7-Stratton JF, Stronge J, Boylan PC. Hyponatremia and non-electrolyte solutions in laboring primigravida. Eur J Obstet Gynecol Reprod Biol 1995;59(2):149-151
8-west CR, Harding JE. Maternal water intoxication as a cause of neonatal seizures. J Pediatr Child Health 2004;40(12):709-10
9-Nordstrom L, Arulkumaran S, et al. Continuous maternal glucose infusion during labor; effects on maternal and fetal glucose and lactate levels. Am J Perina. Am J Perinatol;1995;12(5);357-62
10-http://www.modernmedicine.com/modernmedicine/Modern+Medicine+Now/Normal-saline-is-not-normal-may-be-harmful/ArticleNewsFeed/Article/detail/776186?ref=25
11-Chantry CJ, Nommsen-Rivers LA, Peerson JM et al. Excess Weight Loss in First-Born Breastfed Newborns Relates to Maternal Intrapartum Fluid Balance. Pediatrics 2010

Fire Them

1654409_772290742834062_2112665148391680840_nIt is most important for you to feel completely comfortable with, and even trust, all those who are around you during your labor & birth.
If you don’t, your labor can be impacted by your emotions.
I have seen this happen. I have seen a good labor come to a halt because the woman did not like or was intimidated by those who were caring for her.
If you are feeling the least bit uncomfortable, fire whoever it is that is causing your discomfort.
That’s right! Fire them!
I don’t care if it is your nurse, your doctor or midwife, even me, your doula! Fire them! You have that right!
Even if you are in the middle of your labor…you can fire them!
Then replace them with someone else…
Feeling comfortable with your team is that important!